DR. DONOHUE: Will you give me information on the low-purine diet for gout? — C.J.

ANSWER: Years ago, before effective gout medicines were available, diet was the major treatment for gout. Now, with modern medicines, diet doesn’t play such a big role. Elevated blood uric acid sets the stage for a gout attack. Uric acid infiltrates joints as needle-shaped crystals. Most uric acid comes from the recycling of body cells, a daily process. Only a small amount comes from food. It’s still wise for gout patients to take it easy on foods that are high in purines, but they don’t have to be as strict about diet as former patients had to be. Purines are the substances that produce uric acid.

Gout patients ought to scale back a bit on meat and fish. Anchovies, organ meats like liver and sweetbreads, and gravies have lots of purines in them, and should be taken only once in a while, if at all. Patients need to watch the amount of alcohol they drink. Beer, in particular, often triggers a gout attack. High-fructose corn syrup and table sugar ought to be used in moderation. Soft drinks have a large amount of high-fructose corn syrup in them. These are the only foods that bear some watching.

Milk and other dairy products lessen the chance of gout attacks. All fruits and vegetables can be eaten without any restriction. Weight loss is important for overweight gout patients. That’s about all you need to know about the low-purine diet for gout.

The gout pamphlet explains this quite common and often misunderstood illness. Readers can obtain a copy by writing: Dr. Donohue — No. 302, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the printed name and address of the recipient. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am 48 and have been diagnosed with probable tarsal tunnel syndrome. I had an MRI scan. I have seen three podiatrists, one neurologist and an orthopedic surgeon. I currently am taking ibuprofen and am seeing a physical therapist. I am desperate to avoid surgery. As far as I can see from research, the outcome of surgery is not always positive. I believe physical therapy is causing more inflammation. Can you recommend physicians in my area who are knowledgeable on this disease? — M.S.

ANSWER: Tarsal tunnel syndrome is the ankle’s equivalent of the wrist’s carpal tunnel syndrome. In both, there’s compression of a large nerve that passes through a tunnel of bones and ligaments. In the ankle, the nerve is the posterior tibial nerve. Pressure on that nerve brings on numbness, burning pain or abnormal sensations in the ankle, heel and the foot up to the toes. Swelling in the tunnel through which the nerves passes to enter the foot is the cause of the pain.

Ibuprofen not only reduces pain, but it also quiets inflammation responsible for nerve compression. An injection of cortisone in the area of the nerve can be most helpful when oral medicines are not.

You can call the local hospital for a physiatrist (fizz-EYE-uh-trist), not a psychiatrist. People get the two names mixed up. Physiatrists are doctors who specialize in the nonsurgical treatment of many illnesses, especially bone and joint illnesses.

DEAR DR. DONOHUE: My EKG report, sent to me, says “left axis deviation.” Is that a big deal? — M.Y.

ANSWER: It means that that electric signal originating in the upper heart chamber and responsible for each heartbeat takes a different route to reach the lower heart chambers, the pumping chambers. In the absence of symptoms, it’s not a dangerous thing. You don’t have to dwell on it. I take it you have a doctor who ordered the EKG. That doctor will follow up to see if you have any hidden heart trouble. The condition is not an emergency situation.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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